Microbiologic and economic evaluation of multiday infusion pumps for control of cancer pain.

OBJECTIVE: To confirm established methods and assess bacteriologic and economic consequences for using external portable infusion pumps for the control of cancer pain in the home environment. METHODS: Sixteen patients with terminal cancer were treated subcutaneously or epidurally with continuous infusions of morphine using external multiday infusion pumps. Bacterial growth in the pumps and costs linked to use in a hospital or at home were assessed. Patients treats at home received 2 pumps weekly, marked A for first use and B for second use, patients treated in the hospital received 1 pump every fourth day. After use, the remaining solution in the reservoirs was examined for microbiologic contents. RESULTS: A total of 317 pumps was used and 211 pumps were cultured (66.6%). Growth was found in 16 (7.6%) (Staphylococcus albus in 13, Escherichia coli 2, and Candida albicans in 1 pump). There were no significant differences in contamination between pumps used in the hospital or A or B pumps used at home. No patient showed any signs of clinical infection associated with the infusions. The use multiday devices led to overall cost savings of $284,553 (2.1 million SKr) and a maximum cost savings potential of $379,404 (2.8 million SKr). CONCLUSIONS: The multiday pump system used and the methods established were found to be safe and bacteriologically satisfactory, as well as cost-effective for both hospital and home use.

Decision theory as an aid in the diagnosis of cholestatic jaundice.

Current literature was reviewed for studies on diagnostic value and risk to the patient of different diagnostic techniques in jaundice. It was found that few studies of diagnostic techniques were in fact prospective trials and that many materials were highly selected. Reported figures were used for calculating expected risks and benefits of different investigative strategies. Decision analysis, here applied to a problem not as yet studied with this technique, enable us to compare the outcomes of different strategies and to construct a simple plan for the rational choice of investigative procedures in patients with cholestatic jaundice. According to this plan, following history-taking, physical examination and simple laboratory tests, the investigation should proceed directly with fine-needle PTC whenever the probability of extrahepatic cholestasis is judged to be greater than 87%, and with liver biopsy if this probability is judged to be lower than 2%. In all other cases further investigations should start with ultrasonography.